Navigated Transcranial Magnetic Stimulation in Brain Tumor Surgery

Navigated transcranial magnetic stimulation (nTMS) has emerged as a pivotal non-invasive technique for preoperative functional mapping in patients harbouring brain tumours. By delivering targeted magnetic pulses to the cortex under neuronavigation guidance, nTMS identifies eloquent motor and language regions, delineates the relationship of lesions to critical white matter tracts and quantifies cortical reorganisation induced by tumour growth. Integration of nTMS with advanced imaging modalities—particularly diffusion tensor imaging (DTI) tractography—enables surgeons to visualise the corticospinal tract and language pathways in three dimensions, refine surgical trajectories and maximise the extent of resection while preserving neurological function. Applied routinely in glioma and metastasis surgery, nTMS enhances risk stratification, guides craniotomy planning, informs patient counselling and contributes to improved postoperative motor and language outcomes. Moreover, repeated nTMS assessments reveal patterns of tumour-induced plasticity, offering insights into cortical remapping and potential targets for adjuvant therapies.

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Navigated Transcranial Magnetic Stimulation in Brain Tumor Surgery publication trend

The graph below shows the total number of articles in navigated transcranial magnetic stimulation in brain tumor surgery across all publications each year (not limited to Nature Index journals).

Technical terms

navigated transcranial magnetic stimulation (nTMS): A neuronavigation-guided method that stimulates the cortex non-invasively to map functional brain areas.

diffusion tensor imaging (DTI) tractography: An MRI-based technique that visualises white matter tracts by measuring water diffusion anisotropy.

corticospinal tract (CST): A major white matter pathway conveying motor commands from the primary motor cortex to the spinal cord.

motor-evoked potential (MEP): The electrical response recorded from muscles following cortical stimulation, indicating functional integrity of motor pathways.

centre of gravity (CoG): The calculated cortical coordinate representing the focal point of motor-positive sites for a given muscle group.

plasticity: The brain’s adaptive capacity to reorganise functional networks and redistribute tasks in response to injury or disease.

References

1. Comparison of anatomical-based vs. nTMS-based risk stratification model for predicting postoperative motor outcome and extent of resection in brain tumor surgery. NeuroImage Clinical (2023).
2. Motor mapping of the hand muscles using peripheral innervation‐based navigated transcranial magnetic stimulation to identify functional reorganization of primary motor regions in malignant tumors. Human Brain Mapping (2024).
3. Quantification of tumor induced motor cortical plasticity using navigated transcranial magnetic stimulation in patients with adult-type diffuse gliomas. Frontiers in Neuroscience (2023).
4. Changing the clinical course of glioma patients by preoperative motor mapping with navigated transcranial magnetic brain stimulation. BMC Cancer (2015).
5. A Novel Technique for Region and Linguistic Specific nTMS-based DTI Fiber Tracking of Language Pathways in Brain Tumor Patients. Frontiers in Neuroscience (2016).
6. Resection of Motor Eloquent Metastases Aided by Preoperative nTMS-Based Motor Maps—Comparison of Two Observational Cohorts. Frontiers in Oncology (2016).